THE ASSESSMENT OF COMPETENCE TO MAKE A TREATMENT DECISION - AN EMPIRICAL-APPROACH

Objective: To compare physicians' judgements of competency in routine clinical practice with the findings obtained from a structured clinica l interview. Methods: Ninety-six patients referred for electroconvulsi ve therapy were administered the Competency Interview Schedule (CIS) p rior to their first treatment. Cluster analysis was employed to catego rize patients to I of 5 cluster centres represented by case studies pr eviously judged competent or incompetent by lawyers and health profess ionals. Results: A match-mismatch table revealed 88% (N = 66) of the 7 5 patients found competent by the attending physician and 90.5% (N = 1 9) of the 21 patients found incompetent by the attending physician wer e classified in agreement with the CIS. The 9 misclassified patients f ound competent by the attending physician but classified incompetent b y the CIS had consented to treatment. The 2 misclassified patients fou nd incompetent by the attending physician but classified competent by the CLS had refused treatment. Examination of individual item scores f rom the CIS indicated that, in some cases, a different standard of com petency was applied in routine clinical practice depending upon the pa tient's treatment decision. Conclusions: The CIS is presented as a use ful guide for clinicians with an interest in competency evaluations bu t caution is advised in using the instrument to make formal evaluation s of competency owing to the imprecise definition of competency in var ious jurisdictions.